Achieving RoutIne Screening for Emotional health (ARISE) in pediatric subspecialty clinics.

OBJECTIVE: This study aims to describe the experience of implementing a psychosocial distress screening system for children with serious or chronic medical conditions. METHODS: Achieving RoutIne Screening for Emotional health (ARISE) was developed to systematically evaluate psychosocial distress in children with serious medical or chronic medical illnesses, by integrating patient-reported outcome measures (PROM) into care delivery. ARISE was developed using a user-centered approach with extensive input from patients, families, and healthcare professionals to overcome barriers to routine PROM collection and integration into care as usual. It comprises a system to capture PROMs and then relay results to clinicians for changing care. We sought to implement ARISE at four subspecialty pediatric clinics caring for patients with cystic fibrosis, sickle cell disease, hemophilia, and neurological malignancy. RESULTS: Problems with acceptability, appropriateness, and feasibility represented barriers to implementation which were overcome by modifying the intervention using stakeholder input during the planning phase, leading to broad program acceptance. ARISE was implemented in three of the four clinics, in which 79.8% of eligible children and their family completed PROMs. CONCLUSION: The ARISE program demonstrated the feasibility and effectiveness of integrating psychosocial screenings into subspecialty pediatric clinics, thereby enhancing the identification and management of psychosocial issues in children with serious and chronic medical illnesses.

Associations between mothers' and fathers' depression and anxiety prior to birth and infant temperament trajectories over the first year of life: Evidence from diagnoses and symptom severity.

BACKGROUND: Developmental shifts in infant temperament predict distal outcomes including emerging symptoms of psychopathology in childhood. Thus, it is critical to gain insight into factors that shape these developmental shifts. Although parental depression and anxiety represent strong predictors of infant temperament in cross-sectional research, few studies have examined how these factors influence temperament trajectories across infancy. METHODS: We used latent growth curve modeling to examine whether mothers' and fathers' anxiety and depression, measured in two ways - as diagnostic status and symptom severity - serve as unique predictors of developmental shifts in infant temperament from 3 to 12 months. Participants included mothers (N = 234) and a subset of fathers (N = 142). Prior to or during pregnancy, both parents were assessed for lifetime diagnoses of depression and anxiety as well as current severity levels. Mothers rated their infants' temperament at 3, 6, and 12 months of age. RESULTS: Mothers' depression and anxiety primarily predicted initial levels of temperament at 3 months. Controlling for mothers' symptoms, fathers' depression and anxiety largely related to temperament trajectories across infancy. Lifetime diagnoses and symptom severities were associated with distinct patterns. LIMITATIONS: Infant temperament was assessed using a parent-report measure. Including an observational measure would provide a more comprehensive picture of the infants' functioning. CONCLUSIONS: These results indicate that mothers' and fathers' mental health are uniquely associated with infant temperament development when measured using diagnostic status and/or symptom severity. Future studies should examine whether these temperament trajectories mediate intergenerational transmission of risk for depression and anxiety.

Understanding emerging regulation: The role of frontal electroencephalography asymmetry and negative affectivity.

The present study examined frontal electroencephalography (EEG) asymmetry and negative affectivity (NA) as predictors of infant behaviors during the Still-Face Paradigm (SFP). It was hypothesized that infants with lower NA subscale scores who also demonstrate greater left frontal activation would exhibit more frequent social engagement and self-soothing behaviors during the SFP. Mothers reported infant temperament at 6-12 months of age (N = 62), and EEG was recorded during a baseline task and the SFP. Social engagement, distress, and self-soothing behaviors were coded during the SFP. A three-factor solution emerged based on exploratory factor analysis of eight infant behaviors. After considering bivariate relations, multiple regression analyses predicting the behavior factor labeled social engagement (containing vocalizations and handwaving; average factor loading = .56) were conducted separately for asymmetry and NA subscales, controlling for infant sex and age. The SFP asymmetry predicted social engagement after controlling for covariates and baseline asymmetry; however, NA subscales (falling reactivity and distress to limitations) did not uniquely explain significant variance. These findings highlight the importance of frontal EEG asymmetry in contributing to emerging social engagement and regulation in infancy. Implications include potentially utilizing asymmetry markers as screening and intervention targets in the first year of life.

Play with Mom: Insights into Regulatory Processes at Work during Baseline and Parent-infant Play.

Frontal alpha asymmetry (FAA) is a neural correlate of approach and avoidance motivational processes. This study examined the shift in FAA from baseline to play, associations to parent-reported regulatory abilities, and parent and infant behaviors during play. Infants exhibited greater left frontal alpha activity (more approach) during baseline relative to play. Shifts in FAA toward greater left frontal alpha activity (more approach) from baseline to play were associated with parent ratings of infants' regulatory behaviors and object exploration exhibited during play. These results highlight ongoing regulatory processes involved in positively valenced tasks typical in infants' daily life.

Social context has differential effects on acquisition of nicotine self-administration in male and female rats.

RATIONAL: Smoking typically begins during adolescence or early adulthood in a social context, yet the role of social context in animal models is poorly understood. OBJECTIVES: The present study examined the effect of social context on acquisition of nicotine self-administration. METHODS: Sixty-day-old male and female Sprague-Dawley rats were trained to press a lever for nicotine (0.015 mg/kg, IV) or saline infusions (males only) on a fixed ratio (FR1) schedule of reinforcement across nine sessions in duplex chambers that were conjoined with either a solid wall or a wall containing wire mesh creating a social context between rat dyads (social visual, auditory, and olfactory cues). In a subsequent experiment, sex differences and dose-dependent effects of nicotine [0 (saline), 0.015 or 0.03 mg/kg, IV] were directly compared in rats trained in the isolated or social context on a schedule progressing from FR1 to FR3. These rats were given 20 sessions followed by 3 extinction sessions. RESULTS: We consistently found transient social facilitation of low-dose nicotine self-administration in males during the first session. However, across training overall, we found social suppression of nicotine intake that was most prominent in females during later sessions. CONCLUSIONS: Collectively, these findings suggest that at the age of transition from adolescence to adulthood, a social context enhances the initial reinforcing effects of nicotine in males, but protects against nicotine intake during later sessions especially in females. These findings highlight the importance of sex and social context in studying neural mechanisms involved in initiation of nicotine use.